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Associated Press
Jun. 11, 2018, 9:51 PM

UNITED NATIONS (AP) — The U.N. peacekeeping chief said Monday the situation in Sudan's troubled Darfur region "has changed radically for the better" and the United Nations and the African Union are recommending new sharp cuts in their joint security force.

Jean-Pierre Lacroix told the Security Council the joint mission is finalizing a yearlong process that saw 11 joint sites close and a shift toward peacekeeping in the mountainous Jebel Marra area where intermittent clashes continue while focusing on peacebuilding in the rest of Darfur.

The Darfur conflict began in 2003 when ethnic Africans in the vast western region rebelled, accusing the Arab-dominated Sudanese government of discrimination. The government in Khartoum was accused of retaliating by arming local nomadic Arab tribes and unleashing them on civilian populations — a charge it denies. The U.N.-AU force was established in 2007 with a mandate to help protect civilians in Darfur.

In recent years, as the result of a successful government military campaign, the rebellion has been reduced to rebel Sudan Liberation Army forces loyal to founder Abdul Wahid Elnur in western Jebel Marra.

Sudan's government, stressing the reduction in fighting, has called for the Darfur peacekeeping mission, known as UNAMID, to be wrapped up. The United States has also been pushing for major cuts to U.N. peacekeeping operations.

Lacroix said a strategic review by the U.N. and the AU envisions that over the coming two years peacekeeping would focus on the most precarious areas, now Jebel Marra.

Only a year ago, UNAMID had a ceiling of 15,845 military personnel and 3,403 police. It was reduced significantly at the end of January. The strategic review recommends a further sharp reduction from the current 8,735 to 4,050 military personnel and from 2,500 to 1,870 police officers, Lacroix said.

At the same time, he said, peacebuilding efforts would focus on early recovery projects and development.

"The U.N. system should leverage the capabilities of the agencies, funds and programs best suited to tackling the problems that remain there," Lacroix said.

He said four areas have been identified to enable the Sudanese government, the U.N. country team, civil society and the international community "to carefully and responsibly prepare for the mission's envisaged exit." He said they are improving rule of law including the police; ensuring livelihoods and finding lasting solutions for hundreds of thousands of displaced Darfuris and host communities; ensuring immediate delivery of services to the displaced; and ensuring human rights.

"The situation in Darfur has changed radically for the better since the height of the conflict, and the needs of the people have changed with it," he said.

The strategic report's focus on peacekeeping in Jebel Marra and peacebuilding elsewhere provide a road map "to long-term peace and stability in Darfur," he said. But Lacroix stressed that for this to be achieved "it is essential that longer-term funding arrangements are in place."

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The internal thoracic artery was divided distally. Local immobilization of the anastomotic site was achieved with mechanical stabilizers. The anastomosis was performed with the use of one running 7-0 polypropylene suture on the beating heart. Protamine was applied to partially neutralize the dose of heparin. Wounds were closed in a standard fashion.

In the PCI group, stent implantation was performed after balloon angioplasty dilatation. All patients received aspirin (325 mg daily) before and after the procedure and a 300-mg loading dose of clopidogrel the day before the procedure and 75 mg daily for at least 3 months thereafter. During the procedure all patients were treated intravenously with heparin. In most patients, only one Cypher stent was used for the LAD; however, more than one was used if required (eg, long lesion, dissection). In 2 patients with bifurcation lesion, PCI included treatment of two vessels (LAD and diagonal branch) ( Table 1 Table 1 ).

Acute myocardial infarction (within the previous 48 hours), poor ejection fraction (0.25), left main disease, calcification, or thrombus within the LAD, long lesions (>30 mm) and bifurcation lesions were major criteria for exclusion of patients from the group treated with stents to the LAD. Patients with diabetes mellitus or ostial LAD lesions were not excluded. All patients in the MIDCAB group were treated postoperatively with an intravenous infusion of isosorbide dinitrate (Isoket 4–20 mg/h) during the first postoperative 24–48 hours [ 8 ].

Data are expressed as mean ± SD or proportions, as appropriate. The two groups were matched for age, sex, and extent of coronary artery disease. The χ test and Fisher exact test were used in the stepwise method to compare discrete variables. The Cox proportional hazard model was used to evaluate risk factors for early return of angina and reintervention. Hazard ratio (HR) and 95% confidence interval (CI) were given. Survival Postoperative survival free of angina, major adverse cardiovascular event (MACE), and reintervention are expressed by the Kaplan-Meier method, and comparison between groups was made by the log-rank test. All analyses were performed by SPSS 12 software (SPSS Inc, Chicago, IL).

After matching for age, sex, and extent of coronary artery disease ( Table 1 Table 1 ), the two groups were similar. However, poor ejection fraction (<0.30) was more prevalent in the MIDCAB group, and prior PCI to the LAD was more common among the Cypher group ( Robert Clergerie Satin Platform Wedges for sale discount sale buy cheap great deals IONco
Table 2 ). Two-vessel or three-vessel disease was present in 48% of the patients in both groups. In the PCI group, the relatively high number of untreated vessels reflects a policy of treating the culprit lesions, especially in patients with significant LAD stenosis, without objective evidence for ischemia in the other coronary beds. In the surgical group, the decision to address only the culprit LAD lesion and thus perform a minimally invasive procedure with its associated incomplete revascularization [ 9 ] was made preoperatively by the surgeon together with the patient and the referring cardiologist.

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High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure.

The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45, the guideline authors note. However, only a small increase is expected in the number of adults requiring antihypertensive medication.

"You've already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure," said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. "We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn't mean you need medication, but it's a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches."

Paul K. Whelton, MB, MD, MSc, FACC,

Blood pressure categories in the new guideline are:

The guidelines eliminate the category of prehypertension, categorizing patients as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines. In addition, the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal "white-coat hypertension." Other changes include:

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of the guidelines' impact, Paul Muntner, PhD, et al., suggests "the 2017 ACC/AHA hypertension guideline has the potential to increase hypertension awareness, encourage lifestyle modification and focus antihypertensive medication initiation and intensification on US adults with high CVD risk."

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